TACE术后射频消融与单纯TACE术治疗早、中期肝癌复发率的对比观察

目的对TACE术后再行射频消融(FRA)治疗与单纯TACE术治疗早、中期原发性肝癌的复发率进行对比观察。方法随机抽取2013年1月1日—2014年6月1日在我院接受治疗的76例早、中期原发性肝癌患者,按照入院先后顺序分为对照组、观察组,各38例,分别予以TACE术治疗、TACE术后再行FRA治疗,对比复发率。结果观察组患者3个月、6个月、1年、3年内的肝癌复发率均明显低于对照组,组间对比差异具有统计学意义(P<0.05)。结论 TACE术后射频消融治疗早、中期肝癌,可以显著降低肝癌的复发率,延长患者的生存期。

不同微创介入治疗原发性肝癌对机体T细胞免疫功能的影响

目的探讨微创介入治疗肝癌对机体T细胞免疫功能的影响。方法肝动脉栓塞化疗(TACE)治疗肝癌31例,射频消融(RFA)治疗肝癌19例,根据肿瘤直径大小分为小肝癌组(直径≤5 cm)和大肝癌组(直径>5 cm)。分别于术前及术后1、7 d留置外周血,用流式细胞术检测CD3、CD4、CD8及CD4/CD8比值的变化。结果小肝癌组,TACE与RFA治疗术后1 d外周血T细胞亚群无明显变化,但术后7 d时,RFA治疗组外周血T细胞亚群CD3、CD4、CD8及CD4/CD8比值较治疗前相比明显增高,而TACE组外周血T细胞亚群CD4及CD4/CD8比值较治疗前明显下降。大肝癌组,无论TACE还是RFA治疗,术后1 d外周血T细胞亚群指标较治疗前明显下降(P<0.05),而7 d后外周血T细胞亚群CD3、CD4、CD8及CD4/CD8比值较治疗前显著增高,其中RFA组T细胞亚群较TACE组恢复更为显著。结论不同微创治疗方式治疗肝癌后对机体T细胞免疫系统影响不同,与肿瘤大小密切相关。

Treatment efficacy of radiof requency ablation of 338 patients with hepatic malignant tumor and the relevant complications

AIM： To investigate the treatment efficacy of radiofrequency ablation （RFA） of hepatic malignant tumor and the relevant complications. METHODS： A total of 338 patients with 763 hepatic tumors underwent ultrasound-guided RFA （565 procedures）. There were 204 cases of hepatic cellular carcinoma （HCC） with 430 tumors, the mean largest diameter was 4.0 cm. Of them, 48 patients （23.5%） were in stages Ⅰ-Ⅱ （UICC Systems） and 156 （76.5%） in stages Ⅲ-Ⅳ There were 134 cases of metastatic liver carcinoma （MLC）, with 333 metastases in the liver, the mean diameter was 4.1 cm, the liver metastases of 96 patients （71.6%） came from gastrointestinal tract. Ninety-three percent of the 338 patients were treated using the relatively standard protocol. Crucial attention must be paid to monitor the abnormal changes in ultrasound images as well as the vital signs of the patients to find the possible hemorrhage and peripheral structures injury in time. The tumors were considered as ablated completely, if no viability was found on enhanced CT within 24 h or at 1 mo after RFA. These patients were followed up for 3-57 too. RESULTS： The ablation success rate was 93.3% （401/430 tumors） for HCC and was 96.7% （322/333 tumors） for MLC. The local recurrence rate for HCC and MLC was 7.9% （34/430 tumors） and 10.5% （351333 tumors）, respectively. A total of 137 patients （40.5%） underwent 2-11 times of repeated ablations because of tumor recurrence or metastasis. The 1st, 2nd, and 3rd year survival rate was 84.6%, 66.6%, and 63.1%, respectively; the survival rate from 48 patients of I-II stage HCC was 93.7%, 80.4%, and 80.4%, respectively. The major complication rate in this study was 2.5% （14 of 565 procedures）, which consisted of 5 hemorrhages, i colon perforation, 5 injuries of adjacent structures, 2 bile leakages, and 1 skin burn. CONCLUSION： RFA, as a minimally invasive local treatment, has become an effective and relatively safe alternativefor the patients of hepatic malignant tumor, even of advanced liver tumor, tumor recurrence, and liver metastases. Knowledge about possible complications and their control may increase the treatment efficacy and help to promote the use of RFA technique.

Outcome of transarterial chemoembolization in patients with inoperable hepatocellular carcinoma eligible for radiofrequency ablation

AIM： To evaluate the outcome of transarterial chemoembolization （TACE）in patients with unresectable hepatocellular cardnoma （HCC） 〈5 cm in diameter eligible for radiofrequency ablation （RFA）. METHODS： The treatment-related mortality, morbidity, long-term survival, and prognostic factors of HCC patients who had TACE and fulfilled the present inclusion criteria for RFA were evaluated. RESULTS： Of the 748 patients treated with TACE between January 1990 and December 2002, 114 patients were also eligible for RFA. The treatment-related mortality and morbidity were 1% and 19%, respectively. Survival at 1, 3, and 5 years was 80%, 43%, and 23%, respectively. Older age and a high albumin level were associated with a better survival, whereas a high α-fetoprotein level （AFP） and the size of the largest tumor 〉3 cm in diameter were adverse prognostic factors in multivariate analysis. CONCLUSION： The morbidity, mortality, and survival data after TACE for small HCCs eligible for RFA are comparable to those reported after RFA in the literature. Our data suggest the need for a randomized comparison of the two treatment modalities for small HCCs.

Surgical vs percutaneous radiofrequency ablation for hepatocellular carcinoma in dangerous locations

AIM:To compare the long-term outcome of percutaneous vs surgical radiofrequency ablation(RFA) for hepatocellular carcinoma(HCC) in dangerous locations.METHODS:One hundred and sixty-two patients with HCC in dangerous locations treated with percutaneous or surgical RFA were enrolled in this study.The patients were divided into percutaneous RFA group and surgical RFA group.After the patients were regularly followed up for a long time,their curative rate,hospital stay time,postoperative complications and 5-year local tumor progression were compared and analyzed.RESULTS:No significant difference was observed in curative rate between the two groups(91.3% vs 96.8%,P = 0.841).The hospital stay time was longer and more analgesics were required while the incidence of bile duct injury and RFA-related hemorrhage was lower in surgical RFA group than in percutaneous RFA group(P < 0.05).The local progression rate of HCC in dangerous locations was significantly lower in surgical RFA group than in percutaneous RFA group(P = 0.05).The relative risk of local tumor progression was 14.315 in percutaneous RFA group.CONCLUSION:The incidence of severe postoperative complications and local tumor progression is lower after surgical RFA than after percutaneous RFA.

Comparison of the Outcomes of Monopolar and Bipolar Radiofrequency Ablation in Surgical Treatment of Atrial Fibrillation

Objective To compare the therapeutic effects and safety of monopolar and bipolar radiofrequency(RF) ablation used during cardiac surgery to treat atrial fibrillation.Methods We retrospectively studied a total of 81 patients with chronic atrial fibrillation who underwent open cardiac surgery with concomitant RF ablation between January 2007 and March 2011.Fifty-eight patients received bipolar RF ablation and 23 received monopolar RF ablation,respectively.The sinus rhythm restoration rate,the procedural duration,the frequency of severe perioperative complications,and mortality were compared between the two groups.Results The sinus rhythm restoration rate did not differ significantly between the two groups after follow-up of 15.1 ± 12.6 months(P=0.199).The frequencies of severe perioperative complications and mortality were also similar in the two groups.The total procedural time using bipolar RF ablation was significantly shorter than that using monopolar ablation(19.7±4.6 minutes vs.28.1±8.5 minutes,P< 0.001).Conclusions Both monopolar and bipolar RF ablation are safe and effective in treating chronic atrial fibrillation patients during open cardiac surgery,but bipolar RF ablation is more convenient in practice.

Percutaneous radiofrequency ablation versus repeat hepatectomy for recurrent hepatocellular carcinoma:retrospective randomized control study

Objective:Percutaneous radiofrequency ablation(PRFA) is known to be as effective as hepatectomy for small hepatocellular carcinoma(HCC) in the long-term.We wished to ascertain how it is for recurrent small HCC.Methods:From January 2009 to November 2011,a series of sixty-one patients were included in the study according to the criteria:each patient had one recurrent HCC,less than 5 cm in diameter.Twenty-six of the 61 patients were treated with PRFA and the other 35 were treated with repeat hepatectomy.Results:The interval from first surgery to recurrent for repeat hepatectomy and PRFA groups were(1,239.60±1,017.00) d and(903.42±975.11) d respectively(P=0.066).The tumor-free time after repeat hepatectomy and PRFA were(310.23±159.50) d and(278.27±123.29) d respectively(P=0.584).Size of tumor in repeat hepatectomy and PRFA were(7.34±3.16) cm^2 and(5.59±3.40) cm^2(P=0.215),the total expenditure for each patient of the two groups were(26,150.66±7,923.60) yuan and(21,135.00±1,156.76) yuan(RMB),and the time of hospitalization for each of the two groups were(15.29±4.28) d and(7.46±2.20) d(P<0.001).Conclusion:PRFA is proved to be as effective as repeat hepatectomy in the treatment of recurrent small HCC,and superior to repeat hepatectomy as it is less invasive.

肝癌局部消融治疗规范的专家共识

局部消融治疗是在影像技术的引导下对肿瘤靶向定位,用物理或化学的方法杀死肿瘤细胞;影像引导技术包括超声、CT和MRI;治疗途径有经皮、经腹腔镜手术和经开腹手术三种.局部消融治疗的特点：一是直接作用于肿瘤,具有高效快速的优势;二是治疗范围局限于肿瘤及其周围组织,对机体影响小,可以反复应用.局部消融治疗在过去20年左右发展迅速,已经成为继手术切除、介入治疗后的第三大肝癌治疗手段,而且由于其疗效确切,特别是在小肝癌的治疗方面,射频消融治疗的疗效与手术切除相近,因此,被认为是小肝癌的根治性治疗手段之一.